Case History: 66 y/o Female, Elevated Pancreatic Enzymes, Candidate for Gall Bladder Surgery

I was given permission to share the case of a patient of mine regarding her treatment over the last 14 months. I highlight this case for a number of reasons, which I will get to.

May came into my office late June of last year, referred to me from another patient of mine. She described to me how in October of 2013 she developed burping, burning sensations in the stomach duct, and clay colored stools. I reviewed her labs and indeed she had elevated pancreatic enzymes, elevated liver enzymes, and sludge in her bile duct. Despite the care of her doctors she continued to suffer from her symptomology, which expanded to include frequent diarrhea, acid reflux, bloating, pain, and anxiety. At the time of her first visit she was still under the care of a doctor who was employing a series of her own “custom” formulated supplements, with no positive effect. The next step was to remove her gallbladder, and she had come to me in the hopes I could help prevent this.

In looking through her symptomology the diagnosis seemed obvious, Spleen Deficiency. However, her tongue was regularly shaped with a thin white coat, but with red edges with no coat. Her pulse was quite wiry, with a noticeable weakness in the Earth position and an elevated Ministerial position. This surprised me at first because a true wiry pulse is rare in my experience and I was expecting to find a soft shaoyin type pulse. This is one of the cases where taking the tongue and pulse is ESSENTIAL, as sometimes even the cleverest diagnostician will not see the true pattern presentation based on symptomology alone.

Her shaoyang pulse led to my diagnosis of Liver Qi Yu with Spleen Qi Xu. Over the course of the following year I met with her once a week, modifying the formula with each visit. I eventually found the right combination and dosage of Xiao Chai Hu Tang and Xiang Sha Liu Jun Zi Tang. Over the proceeding months she would progress through stages of symptomology resolution; symptoms would resolve and then return, get better then get worse, as her bowels and digestion slowly returned to normal. After four months of treatment the labs revealed that her pancreatic and liver enzymes all returned to normal. Then, last week, an ultrasound revealed that her gallbladder is “pristine”, in the words of the technician, and surgery is no longer required.

This was not a linear clean process. It was a difficult case and as with all difficult cases there is an element of trial and error that is required to arrive at the correct diagnosis. It is an ongoing, maturing process as the physician becomes more familiar with their patient and the factors giving rise to their diagnostic patterns. In May’s case I eventually came to know her and her past issues with prolonged anger that gave rise to her present condition. As a patient, because she was compliant with treatment and didn’t give up on her physician, she achieved her objective. I, too, had to have confidence in my training and the courage to admit what needed to be changed, and what needed to endure until resolution occurred in the fullness of time.

Point prescription: GB 42, SJ5, LI 10, St 36, Lv 4, Ren 4, St 25, GB 24, Lv 14, Yintang, ear Shenmen, ear GB, ear Heart. Current formula: Bai Shao 6, Fu Ling 4.5, Cang Zhu 4.5, Sheng Jiang 3, Sha Ren 3, Qing Pi 3, Mu Xiang 4.5, Bai Ren Shen 3, Bai Zhu 6, Gan Cao 3, Ban Xia 6, Huang Qin 3, Chai Hu 9.

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